Treatment of anal fistula depends on the fistula's location and complexity. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Damage to these muscles can lead to fecal incontinence.
The options include:
- Fistulotomy. The surgeon cuts the fistula's internal opening, scrapes and flushes out the infected tissue, and then flattens the channel and stitches it in place. To treat a more complicated fistula, the surgeon may need to remove some of the channel. Fistulotomy may be done in two stages if a significant amount of sphincter muscle must be cut or if the entire channel can't be found.
- Advancement rectal flap. The surgeon creates a flap from the rectal wall before removing the fistula's internal opening. The flap is then used to cover the repair. This procedure can reduce the amount of sphincter muscle that is cut.
- Seton placement. The surgeon places a silk or latex string (seton) into the fistula to help drain the infection.
- Fibrin glue and collagen plug. The surgeon clears the channel and stitches shut the internal opening. Special glue made from a fibrous protein (fibrin) is then injected through the fistula's external opening. The anal fistula tract also can be sealed with a plug of collagen protein and then closed.
- Ligation of the intersphincteric fistula tract (LIFT). LIFT is a two-stage treatment performed at Mayo Clinic's campus in Florida for more-complex or deep fistulas. LIFT allows the surgeon to access the fistula between the sphincter muscles and avoid cutting them. A seton is first placed into the fistula tract, forcing it to widen over time. Several weeks later, the surgeon removes infected tissue and closes the internal fistula opening.
In cases of complex fistula, more-invasive procedures may be recommended, including:
May 06, 2015
- Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert waste into a collection bag, to allow the anal area time to heal.
- Muscle flap. In very complex anal fistulas, the channel may be filled with healthy muscle tissue from the thigh, labia or buttock.
- Abscess and fistula expanded information. American Society of Colon and Rectal Surgeons. https://www.fascrs.org/patients/disease-condition/abscess-and-fistula-expanded-information. Accessed April 19, 2015.
- Anorectal fistula (fistula in ano). The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anorectal-fistula. Accessed April 20, 2015.
- Cook AJ. Decision Support System. Mayo Clinic, Rochester, Minn. April 16, 2015.
- Schwartz DA, et al. The role of imaging tests in the evaluation of anal abscesses and fistulas. http://www.uptodate.com/home. Accessed April 20, 2015.
- Breen E, et al. Anorectal fistula: Clinical manifestations, diagnosis, and management principles. http://www.uptodate.com/home. Accessed April 20, 2015.
- Wolff BG (expert opinion). Mayo Clinic, Rochester, Minn. April 23, 2015.
- Pigot F. Treatment of anal fistula and abscess. Journal of Visceral Surgery. In press. Accessed April 23, 2015.